Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking.

Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12-17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant's momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.

The relationship between metacognition, anger, and pain intensity among fibromyalgia patients: a serial mediation model.

Fibromyalgia is a burdensome pain causing patients a very negative emotional state that can worsen their clinical profile, perceived disability, and treatment outcomes. In particular, anger can negatively affect pain and patient adjustment to the disease. Recent studies suggest that metacognitions and anger rumination can negatively affect anger, which in turn can amplify the intensity of pain. This study aims to investigate whether anger rumination and state anger serially mediate the relationship between metacognitions and the intensity of pain. The study included 446 subjects who: declared having received a fibromyalgia diagnosis by a rheumatologist/pain physician; completed measures of metacognitions, anger rumination, state-anger, and pain intensity. The serial mediation analysis was conducted using Hayes' PROCESS macro (Model 6). Negative beliefs about worry and beliefs about the need to control thoughts indirectly influenced the intensity of pain through two significant mediating pathways: state-anger and anger rumination to state-anger. Cognitive self-consciousness affected pain intensity directly (ß = .11, p < .05) and indirectly through two significant mediating pathways: state-anger and anger rumination to state-anger. This study highlights the role of serial mediation of anger rumination and state-anger in the relationship between metacognitions and pain intensity in the field of fibromyalgia. Our work introduces new targets for anger management interventions for patients with fibromyalgia. Such interventions could be effectively addressed with a metacognitive approach considering its specific focus on dysfunctional metacognitive beliefs and repetitive negative thinking.

Cognitions and Metacognitive Beliefs in Posttraumatic Stress Disorder.

OBJECTIVE: There has been an increasing interest in understanding what contributes to the development and what maintains posttraumatic stress disorder (PTSD). The cognitive model emphasizes that it is a disturbance of the autobiographical memory for the trauma, cognitive beliefs and maladaptive behaviour that maintain trauma symptoms. Interventions are based on cognitive restructuring and behaviour experiments to modify these beliefs. In contrast, the metacognitive model emphasizes that it is the metacognitive beliefs that give rise to the cognitive attentional syndrome (CAS) that maintain trauma symptoms. The focus of treatment is reducing CAS and working on metacognitive beliefs. The aim of this study was to explore the contribution of cognitions and metacognitive beliefs to trauma symptoms and investigate what predicts symptom burden in traumatized patients. METHOD: Participants (N = 290) diagnosed with PTSD were included, and hierarchical multiple regression analyses were performed to explore if cognitions and metacognitive beliefs explained additional and independent variance in trauma symptoms while controlling for age and gender. RESULTS: Both cognitions and metacognitive beliefs contributed independently and significantly to predicting trauma symptoms. CONCLUSION: The results provide further support for investigating what maintains trauma symptoms and what to target in treatment. This may have clinical implications for our theoretical and practical understanding of PTSD.

A systematic review of the relationship between generic and specific metacognitive beliefs and emotion dysregulation: A metacognitive model of emotion dysregulation.

Although a probable association between metacognitive beliefs (also termed 'metacognitions') and emotion dysregulation has been suggested in the literature, the evidence is still sparse and inconclusive. The current study aims to present a comprehensive evaluation of the literature examining the association between metacognitive beliefs and emotion dysregulation. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'metacognitions/metacognitive beliefs/positive metacognitive beliefs/negative metacognitive beliefs/cognitive self-consciousness/beliefs about the need to control thoughts/cognitive confidence/negative beliefs about thoughts concerning uncontrollability and danger/AND difficulties emotion regulation/emotion dysregulation'. A total of 19 studies met the inclusion criteria. In both non-clinical and clinical populations, a higher endorsement of dysfunctional metacognitive beliefs was found to be associated with emotion dysregulation and vice versa. A higher endorsement of metacognitive beliefs may be associated, either directly or via maladaptive forms of mental control (e.g., worry, rumination and suppression) to emotion dysregulation. Metacognitive beliefs could be the potential therapeutic target in clinical interventions aimed at reducing emotion regulation difficulties.

Role of Worry in Addiction: Implication of Metacognitive Beliefs and Type 2 Worry.

INTRODUCTION: According to the self-medication hypothesis, worriers use substances to cope with their symptoms; however, some published results have challenged this hypothesis. The aim of this study is to show if worry increases the risk of SUD when it is negatively appraised by negative metacognitive beliefs. METHOD: We recruited three samples: 68 patients with a severe AUD, 27 patients dependent on eating and 42 control participants. We used the Yale Food Addiction Scale-2, the Metacognitions Questionnaire-65, the UPPS-P Impulsive Behaviour Scale and the Anxiety Thoughts Inventory. RESULTS: We confirmed a direct effect of worries and metaworry on alcohol (AUD) and eating addiction (EA), but our multivariate analyses revealed that metacognitive beliefs and metaworry are the most robust predictors of alcohol and eating addiction. DISCUSSION: We reported substance-related differences in the relationship between worry and addiction. AUD is related to the metacognitive activity set in motion by worries while EA is associated with a maladaptive form of worry (meta-worry) where worries are negatively interpreted.

The relationship between childhood trauma, eating behaviours, and the mediating role of metacognitive beliefs.

Disordered eating poses a significant risk to psychological and physical health. The experience of childhood trauma has been linked to the development of disordered eating behaviours, but the causal psychological mechanisms remain unclear. The metacognitive model holds promise as a potential framework for understanding the mediating psychological processes that explain how childhood trauma may lead to disordered eating. The purpose of this study was to examine the role of metacognitive beliefs mediating the relationship between childhood trauma and disordered eating behaviours. Adults from the Australian community (N = 461) completed an online self-report survey measuring childhood maltreatment (Childhood Trauma Questionnaire - Short Form), disordered eating behaviour (Three Factor Eating Questionnaire - Revised 21), and metacognitive beliefs (Metacognitive Questionnaire 30). Hierarchical multiple regression analyses revealed no independent associations between any forms of childhood maltreatment and cognitive restraint, while childhood emotional abuse was uniquely associated with uncontrolled eating and emotional eating. Through bootstrapping tests, the mediating effect between childhood trauma and uncontrolled and emotional eating consistently involved the metacognitive beliefs that thoughts are uncontrollable and dangerous. Future longitudinal research is required to confirm causal relationships.

Validity and Reliability of the Metacognitions Questionnaire-30 (MCQ-30) among Chinese Adolescents.

This study aimed to examine the psychometric properties of the Metacognitions Questionnaire-30 (MCQ-30) in a sample of Chinese adolescents (1382 boys, 1445 girls) aged 11 to 18 years. Confirmatory factor analysis was performed to assess factor structure, as well as, measurement invariance across demographic groups and clinical symptoms. The results of confirmatory factor analyses supported the original five-factor model. Configural, metric and scalar invariance of the five-factor model were also supported by gender, age, ethnicity, residence, parental education level, depression and anxiety status. Furthermore, all five subscales demonstrated good internal consistency (Cronbach alphas > 0.75) and test-retest reliability (intra-class correlation coefficients > 0.45). Finally, the five factors were positively related to symptoms of depression, anxiety, and irritability and negatively related to positive childhood experiences and life satisfaction, indicating excellent validity. The findings provide initial evidence that the MCQ-30 is a valid measure for use in Chinese adolescents.

Examining the Longitudinal Relationship Between Metacognitive Beliefs and Psychological Distress in an Adolescent Population: A Preliminary Analysis.

Adolescence is a period marked by significant vulnerability to the onset of mental health concerns. Within adults, the metacognitive model of psychological disorders advocates for the involvement of metacognitive beliefs in the onset, and maintenance, of psychopathology. The current study aimed to assess the applicability of the metacognitive model in adolescence by exploring the relationship, as well as the trajectory, between metacognitive beliefs and psychological distress. The longitudinal prospective cohort study investigated data from a community-based sample of participants aged 12 to 13. Self-report assessment measures of metacognitive beliefs, psychological distress, and somatic distress are reported across four time-points. Baseline assessments are reported for 70 participants, which reduced to 53 participants at time-point four. Correlational analyses demonstrated a significant relationship between overall metacognition, as well as negative metacognitive beliefs, and psychological distress at each of the four time-points. Generalised Estimating Equations found a significant association between metacognitive predictors and psychological distress over the four time-points. These results indicate that negative metacognitive beliefs, positive metacognitive beliefs, metacognitive beliefs related to superstition, punishment, and responsibility, low perceived levels of cognitive confidence and cognitive self-consciousness predict psychological distress over 12 months in adolescents aged 12 to 13. The strongest longitudinal correlational structure was found for the model of negative metacognitive beliefs and psychological distress. These findings provide preliminary evidence for the positive linear relationship between metacognitive beliefs and psychological distress in adolescence. The study provides an important contribution to understanding the role of metacognitive beliefs in the aetiology and perpetuation of psychological distress in adolescence.

Metacognitive beliefs predict interpersonal problems in patients with social anxiety disorder.

Patients with Social Anxiety Disorder (SAD) typically report interpersonal problems, and these are important targets in treatment beyond social anxiety symptoms as they impair quality of life, maintain emotion symptoms and effect on social functioning. What factors contribute to interpersonal problems? In the current study we set out to explore the role of metacognitive beliefs as correlates of interpersonal problems in patients treated for SAD when controlling for the effect of social phobic cognitions and symptoms. The sample consisted of 52 patients with a primary diagnosis of SAD participating in a randomized controlled trial comparing cognitive therapy, paroxetine, pill placebo, or the combination of cognitive therapy and paroxetine in treating SAD. Two hierarchical multiple linear regression analyses were conducted to explore change in metacognitions as predictors of change in interpersonal problems when controlling for change in social phobic cognitions and social anxiety. Change in metacognitions accounted for unique variance in interpersonal problems improvement beyond change in cognitions. Furthermore, change in cognitions overlapped with change in social anxiety symptoms, and when controlling the overlap between these three predictors, only change in metacognitions was uniquely associated with improvement in interpersonal problems. This finding indicates that metacognitions are linked to interpersonal problems in patients with SAD with the implication that treatment should aim to modify metacognitive beliefs to alleviate interpersonal dysfunction.

The metacognitive link between co-occurring intra- and interpersonal symptoms in major depression.

OBJECTIVES: Co-occurring symptoms in depressed people currently in a relationship are sometimes considered to be due to interpersonal variables like dyadic adjustment, or intrapersonal factors such as a lack of dispositional mindfulness. Recent theories of emotional distress have, however, proposed that metacognitive beliefs could be a better link between these frequently co-occurring symptoms in major depression. METHODS: In a French sample of depressed inpatients currently in a relationship (n=30), we conducted a mediation analysis to assess whether the score of the Metacognitions Questionnaire-30 mediated the relation between on the one side the Beck depression inventory and on the other side the dyadic adjustment scale, the Beck anxiety inventory, and the five facets mindfulness questionnaire. RESULTS: By using a multiple linear regression and the Sobel test, we found that the Metacognitions Questionnaire fully mediated the association of depression severity with both anxiety and the affectionate expression of the Dyadic Adjustment Scale, and partially mediated that of the Five Facets Mindfulness Questionnaire with depression severity. CONCLUSIONS: These results obtained in a clinical sample gave support for the mediating role of dysfunctional metacognitive beliefs on some aspects of depressive symptomatology, as well as the likely metacognitive nature of important dispositional mindfulness facets. Limitations of this study are discussed, including its cross-sectional design as well as its sample size.

Psychological factors associated with clinical fear of cancer recurrence in breast cancer patients in the early survivorship period.

OBJECTIVES: Clinical fear of cancer recurrence (FCR) is highly prevalent among breast cancer patients and appears early in the disease trajectory. A better understanding of psychological factors associated with clinical FCR is essential to guide screening and intervention development. This cross-sectional study aimed to assess the contribution of attentional bias, intrusive thoughts, metacognitive beliefs, intolerance of uncertainty, thought suppression, and worry to clinical FCR in breast cancer patients in the early survivorship period. METHODS: Seventy-four patients treated for non-metastatic breast cancer were enrolled at the end of their treatment. The FCR Inventory-Short Form (FCRI-SF) was used to discriminate between the patients with clinical versus nonclinical FCR. Attentional bias to negative and positive cancer-related and non-cancer-related emotional words was assessed with a dot-probe task. Words were presented for 17, 500, and 1500 ms. Intrusive thoughts and thought suppression were assessed with the White Bear Suppression Inventory, metacognitive beliefs with the Metacognitions Questionnaire-30, intolerance of uncertainty with the Intolerance of Uncertainty Inventory-Part A, and worry with the Penn State Worry Questionnaire. RESULTS: According to univariate analyses, the patients with clinical FCR (FCRI-SF ≥13) significantly differed from those with nonclinical FCR in terms of intrusive thoughts (p = 0.002), metacognitive beliefs (p = 0.029), intolerance of uncertainty (p < 0.001), and worry (p < 0.001). Intolerance of uncertainty (odds ratio, OR = 1.06; p = 0.040) and worry (OR = 1.09; p = 0.013) remained in the final logistic regression models. All the patients showed vigilance to cancer-related words, whether with negative or positive valence, at automatic stages of processing (17 ms). CONCLUSIONS: Intolerance of uncertainty and worry were the two psychological factors contributing directly to clinical FCR in our cross-sectional study. In addition, attentional bias did not differentiate breast cancer patients with clinical versus nonclinical FCR. Treatment approaches for clinical FCR in early survivorship care may need to integrate uncertainty and worry management intervention strategies.

Mediating role for metacognitive processes in the relationship between schizotypy and anxiety and depression symptoms.

Introduction: Depression and anxiety symptoms are highly prevalent in schizophrenia-spectrum disorders and are commonly associated with schizotypy in non-clinical samples. However, it remains unclear what factors could be contributing to the relationships between schizotypy and anxiety and depression symptoms. Using path analysis, we explored the complex interplay between schizotypy, metacognitive beliefs, cognitive insight, and symptoms of emotional distress.Methods: Self-report data of schizotypy, metacognitive beliefs, cognitive insight, depression, and anxiety symptoms were collected from 344 participants from a predominantly student sample.Results: Path analysis confirmed unique associations between schizotypy dimensions, metacognitive beliefs, and cognitive insight. Furthermore, negative beliefs about worry mediated the link between the schizotypy dimensions, unusual experiences, cognitive disorganisation, and introvertive anhedonia and both depression and anxiety symptoms. Lack of cognitive confidence also mediated the relationship between cognitive disorganisation and depression symptoms. Finally, the cognitive insight subcomponent self-reflectiveness mediated the relationship between unusual experiences and cognitive disorganisation and anxiety.Conclusions: This study significantly furthers our understanding of the complex relationship between schizotypy, metacognitive processes, and emotional distress. Our findings also provide support for interventions which modify metacognitive beliefs and self-reflectiveness, which may prove beneficial for treatment in clinical settings.

Unusual experiences and their association with metacognition: investigating ASMR and Tulpamancy.

BACKGROUND: Unusual experiences in Tulpamancer and Autonomous Sensory Meridian Response (ASMR) communities are generally positive and sought after, unlike hallucinations and delusions in clinical populations. Metacognition, the ability to reflect on self-referential experiences, may aid sense-making around unusual experiences, reducing distress. This study investigated group differences in hallucination-proneness, delusion-proneness, and metacognition in these communities compared to controls, and whether metacognition predicted unusual experiences. METHODS: 243 participants reporting ASMR, Tulpamancy, or neither, with no history of psychosis, took part in an online observational study. Participants completed the Beck Cognitive Insight Scale, Metacognitions Questionnaire-30, and Brief Core Schema Scales to capture metacognition. A Tulpamancer+ (reporting ASMR) group was identified and included in analyses. ANCOVAs highlighted group differences in hallucination-proneness, with Tulpamancer+ scoring higher, and metacognitive beliefs, with Tulpamancers reporting lower metacognitive belief endorsement. There were no group differences in delusion-proneness, self-reflection, or self-schemas. Stepwise regression demonstrated metacognition does influence unusual experiences in the non-clinical population, and this influence varies across groups. CONCLUSIONS: In non-clinical populations, unusual sensory experiences are not associated with increased metacognitive beliefs, but having multiple unusual experiences is associated with higher hallucination-proneness. Results suggest improving metacognition in clinical groups may help reduce distress related to unusual sensory experiences.

The Short Version of the Metacognitive Anger Processing Scale (MAP-SV) - initial psychometric testing.

BACKGROUND: The 26-item version of the Metacognitive Anger Processing Scale (MAP) has shown good psychometric properties in previous studies. However, there is a need for a shorter version of the scale. AIMS: The aim of the present study is to psychometrically evaluate the 9-item Metacognitive Anger Processing Scale - Short Version (MAP-SV) in comparison with the original, 26-item version. METHOD: The 26-item MAP includes three subscales: rumination, positive beliefs and negative beliefs. Three items from each subscale were selected based on clinical validity to constitute the 9-item MAP-SV. A previous sample used for validation of the 26-item MAP was used for clinimetric testing. The sample included psychiatric patients (n = 88) and male forensic inpatients (n = 54). The MAP-SV was assessed according to scalability, convergent validity with general metacognition, and concurrent validity with anger measures. RESULTS: The scalability of the 9-item MAP-SV was comparable to that of the original 26-item MAP in most psychometric tests. The Loevinger's coefficient of homogeneity for the total score of the MAP-SV items was 0.29 for the combined sample compared with 0.36 in the original MAP, indicating close to acceptable scalability. The alpha coefficient for the MAP-SV total score was 0.79. For the combined sample, Pearson inter-correlations between the subscales of the MAP-SV were highly correlated with the MAP-SV total score (ranging from .66 to .84). CONCLUSIONS: The 9-item MAP-SV showed good psychometric properties and can be used as a reliable tool for assessing self-reported metacognitive anger processing.

Metacognitive beliefs about uncontrollability relate most strongly to health anxiety among US-based non-Latinx White primary care patients: Comparing strength of relations with US-based non-Latinx Black and Latinx primary care patients.

Metacognitive beliefs have emerged as important to health anxiety, particularly beliefs that health-related thoughts are uncontrollable. Preliminary research examining generalized worry indicates uncontrollability beliefs relate more strongly to anxiety among US-based self-identifying White relative to Black college students. The present study sought to extend that line of research by examining if metacognitive beliefs about the uncontrollability of health-related thoughts differentially relate to health anxiety among self-identifying non-Latinx Black (n = 123), Latinx (n = 104) and non-Latinx White (n = 80) US-based primary care patients. As predicted, although positive associations were seen across all three groups, beliefs that health-related thoughts are uncontrollable more strongly related to health anxiety among White patients compared to both Black and Latinx patients. Those differential relations held in multivariate analyses while statistically controlling for positive depression screening status, generalized anxiety symptom severity and medical morbidity. Although the effect size surrounding the differential relations was small in magnitude, the present results further support the notion that metacognitive beliefs about uncontrollability relate less strongly to anxiety among US-based ethnoracial minorities compared to White individuals. Potential reasons for the differential relations are discussed, along with additional areas for future research.

The metacognitive model of post-traumatic stress disorder and metacognitive therapy for post-traumatic stress disorder: A systematic review.

The metacognitive model of post-traumatic stress disorder (PTSD) implicates metacognitive beliefs, meta-memory beliefs and metacognitive control strategies in perpetuating and maintaining symptoms of PTSD. Despite this expanding area of research, the evidence for the metacognitive model of PTSD has not been reviewed. A systematic review according to the PRISMA statement was conducted. Searches across MEDLINE, PubMed and PsycNET, as well as reference lists of the included studies (2004 to March 2020), yielded 221 records. Two independent reviewers screened articles, which were included where the impact of the constructs of interest on PTSD symptoms was investigated within the framework of the metacognitive model for PTSD. Eighteen articles were included in the review. Eleven studies were determined to have good methodological robustness. Metacognitive therapy for PTSD demonstrated reductions in symptoms from pretreatment to post-treatment, which were maintained at follow-up. Predictors of greater PTSD symptom severity included metacognitive beliefs, meta-memory beliefs, and worry, punishment, thought suppression, experiential avoidance, and rumination. Overall, support was found for the validity of the metacognitive model of PTSD.

Repetitive negative thinking, metacognitive beliefs, and their interaction as possible predictors for problematic cannabis use.

The metacognitive formulation of addictive behaviours considers repetitive negative thinking (RNT) and metacognitive beliefs as two important processes involved in the development and maintenance of addictive behaviours. To date, very limited research has investigated the implication of these processes in problematic cannabis use. The present study was aimed at exploring the association between RNT, metacognitive beliefs, and cannabis use in a sample of 157 problematic cannabis users. Participants were administered measures of cannabis use severity, RNT, metacognitive beliefs, anxiety, and depression. Multiple regression analysis showed that metacognitive beliefs (cognitive confidence, beliefs about the need to control thought, and cognitive self-consciousness) were independent predictors of problematic cannabis use and related problem severity when controlling for RNT and negative affect (anxiety and depression). Furthermore, RNT predicted problematic cannabis use severity only for users with low levels of negative beliefs about thoughts concerning uncontrollability and danger. These data suggest that metacognitive beliefs and RNT may be two relevant cognitive processes for understanding problematic cannabis use. More generally, it enables the consideration of cannabis use from the perspective of self-regulation theories, and more specifically cognitive regulation, thus offering several theoretical and clinical implications.

Association between Metacognitive Beliefs and COVID-19 phobia in a community population: a cross-sectional study.

This study aims to investigate the relationship between metacognitive beliefs and COVID-19 phobia. The sample included 514 Turkish adults, 295 of whom are women (57,4%), and 219 are men (42,6%). Their ages ranged between 18 and 70 years (M = 32.96, SD = 10.79). COVID-19 Phobia Scale (C19P-S) and Metacognitions Questionnaire-30 (MCQ-30) were administered. Our analysis showed that women reported significantly higher COVID-19 phobia. The participants with chronic illnesses showed significantly higher COVID-19 phobia and MCQ-30 scores. It was found that C19P-S total score positively correlated with negative beliefs about worry concerning uncontrollability of thoughts, the need to control thoughts, cognitive self-consciousness, positive beliefs, cognitive confidence, and MCQ-30 total score respectively (r = .47, p < .001; r = .33, p < .001; r = .30, p < .001; r = .29, p < .001; r = .12, p < .001; r = .44, p < .001). Then, hierarchical multiple regression was conducted, and the relationships were tested via structural equation modeling. To sum up, it can be concluded that negative beliefs about worry concerning the uncontrollability of thoughts contribute to COVID-19 phobia. However, explained variance was small suggesting that there are additional factors involved. These results provided preliminary findings relating to the association between metacognitive beliefs and coronavirus phobia symptoms. Further longitudinal research is necessary to determine the causal direction of these findings.

Group meta-cognitive therapy and depression in women with breast cancer: a randomized controlled trial.

BACKGROUND: Breast cancer is one of the most common cancers in Iranian women. They will experience a mental health problem like depression before, during or after treatment. This study aimed to determine the effectiveness of group metacognitive therapy on depression, cognitive-emotional regulation, and meta-cognitive beliefs in women with breast cancer. METHODS: In this randomized controlled clinical trial, a total of 24 depressed patients with breast cancer were randomly allocated to experimental and control groups. The experimental group received meta-cognitive therapy in 8 weekly sessions, but the control group received treatment as usual. Beck Depressive Inventory, cognitive emotion regulation questionnaire, and meta-cognitions questionnaire were completed before, after and one month after the intervention. Data were analyzed using Wilcoxon and Chi-square tests. RESULTS: The mean score of depression in the experimental group was reduced from 21.6 ± 4.83 in the pre-test to 13.83 ± 8.12 in one-month follow-up (p = 0.16); however, there was no significant difference in the control group. The mean score of cognitive emotion regulation did not show a significant change in the two groups during the study and follow-up period. The mean score of meta-cognitive beliefs reached 68.75 ± 15.74 from 79.51 ± 10.72 in the experimental group during the follow-up period (p = 0.006); however, there was no significant difference in the control group in the score of metacognitive beliefs. CONCLUSION: These findings support the efficacy of meta-cognitive therapy as a viable psychosocial intervention in depressed patients with breast cancer. Trial registration IRCT201606288473N5. Registered on: 05/09/2016 https://www.irct.ir/trial/8946 .

The moderating effect of age on the associations of cognitive and metacognitive beliefs with pediatric OCD symptoms.

Although considerable research has highlighted the importance of cognitive and metacognitive beliefs in adult obsessive-compulsive disorder (OCD), there has been limited investigation of these beliefs in pediatric OCD. The present study investigated the clinical correlates of cognitive and metacognitive beliefs in pediatric OCD. Previous studies found positive relations between OCD symptoms and these beliefs in pediatric patients, and we hypothesized these beliefs would also be positively related to pediatric OCD symptom severity. We additionally hypothesized age would moderate these relationships in consideration of previous studies highlighting age differences in symptom presentation and self-reported beliefs. We also explored age differences in belief endorsements. Youth aged 7-17 (n = 142) diagnosed with OCD completed self-report scales to measure cognitive and meta-cognitive beliefs. OCD severity was assessed using self-report and clinician-rated measures. Pearson correlations, moderation analyses, and independent-samples t-tests were used to test our hypotheses and aims. Significant positive relationships were observed between cognitive and metacognitive beliefs and self-reported OCD severity, although age did not moderate these relationships. Age differences were found in belief endorsements. In conclusion, cognitive and metacognitive beliefs appear clinically relevant to pediatric OCD cases, and we recommend clinicians assess these beliefs and incorporate cognitive components to corresponding evidence-based treatment.